Is Temporomandibular Joint Arthroscopy Effective in Managing Pediatric Temporomandibular Joint Disorders in the Short- and Long-Term?

Abstract

Although temporomandibular joint (TMJ) arthroscopy outcomes have been well documented in the adult population, conclusive data are lacking for pediatric patients with TMJ disorders. The aim of the present study was to evaluate the early and late outcomes of TMJ arthroscopy in the pediatric population. We performed a retrospective analysis to evaluate the short- (1-month) and long-term (1-year) improvements in the visual analog scale (VAS) scores for pain after pediatric TMJ arthroscopy from 2008 to 2016. The arthroscopic interventions varied according to the diagnostic findings and Wilkes classification. The primary outcome variable was the magnitude of VAS score for pain (0, no pain; 100, worst pain) at 1year postoperatively. The secondary outcome variables were the short-term for the VAS score for pain and the short- and long-term outcomes for perceived jaw dysfunction (0, normal jaw function; 100, complete jaw dysfunction), mouth opening, joint loading (contralateral joint pain when biting on the canine), joint noise, and muscle pain. Univariate, bivariate, and multivariate statistical analyses were performed with the significance level set at P<.05. A total of 23 patients (37 joints), with a mean age of 14.1years (range, 12.8 to 16.7years) had undergone TMJ arthroscopic surgery with short- and long-term postoperative follow-up data available. The VAS scores for pain showed average improvements of 26% in the short-term (P<.0001) and 25% in the long-term (P<.0008). Perceived jaw dysfunction showed an average improvement of 23.8% in the short-term (P<.0001) and 19.2% in the long-term (P<.0008). The average mouth opening had improved by 5.4mm in the short-term (P<.0016) and 8.2mm in the long-term (P<.0001). Controlling for stage and diagnosis, the patients with Wilkes III showed the most benefit with statistically significant improvements in pain, jaw dysfunction, maximum interincisal opening, and joint loading pain. TMJ arthroscopy could be an effective and minimally invasive form of surgical intervention for treating Wilkes II, III, and IV TMJ disorders in the pediatric population.